POS0386 A NOVEL ECHOCARDIOGRAPHY METHOD FOR THE DETECTION OF SUBCLINICAL MYOCARDIAL FIBROSIS IN PATIENTS WITH SYSTEMIC SCLEROSIS: A CROSS-SECTIONAL STUDY.
Authors: A. Giollo, G. Cioffi, F. Ognibeni, F. Aldegheri, R. Bixio, I. Gavioli, D. Rotta, E. Bertoldo, G. Orsolini, D. Gatti, M. Rossini, O. Viapiana
Journal: Annals of the Rheumatic Diseases (2022)

Background Scar imaging echocardiography with ultrasound multi-pulse scheme (eSCAR) is a novel technique allowing detection of myocardial scars. eSCAR has never been explored in patients with systemic sclerosis (SSc). Objectives The aim of our study was to examine whether eSCAR may detect subclinical myocardial fibrosis in SSc. Methods In this cross-sectional study conducted between 11/2020 and 02/2021, consecutive SSc patients from the University of Verona underwent cardiovascular disease (CVD) screening procedures including standard transthoracic echocardiography (TTE) and myocardial scars detection through the eSCAR technique. We excluded patients with prior history of structural heart disease and pulmonary hypertension. To validate eSCAR findings, we assessed myocardial function through global longitudinal strain (GLS) analysis by speckle tracking echocardiography (STE). We also conducted a case-control study comparing eSCAR findings in randomly selected SSc patients and non-SSc controls matched 1:1 for age, sex and number of CVD risk factors. The primary outcome was the proportion of patients with myocardial scars. Principal component analysis (PCA) was used to determine main eSCAR patterns. Multivariable linear regression analysis was used to minimise confounding. Results Scar imaging echocardiography revealed that 42/92 (44%) SSc patients had myocardial scars involving a median [25th-75th percentile] of 4 [1-7] segments. PCA identified that myocardial scars localised mostly at the inferior and septal segments (inferoseptal pattern; Figure 1). STE validation confirmed that GLS was significantly reduced in SSc patients with inferoseptal scars (Table 1). Otherwise, all standard echocardiography measures were normal in both groups. In multivariable regression analysis, prior digital ulcerations (B=0.41, 95% CI 0.008 to 0.809, p=0.045) and body mass index (B=-0.06, 95% CI -0.113 to -0.015, p=0.012) were both significantly and independently associated with inferoseptal myocardial scars. Myocardial scars were found in 38% of SSc patients and no matched controls (p&lt;0.0001). Table 1. Comparison of speckle tracking echocardiography (longitudinal myocardial strain) in eSCAR-positive (inferoseptal pattern) and eSCAR-negative (no inferoseptal pattern) patients. Speckle tracking echocardiography eSCAR-positive (n= 8) eSCAR-negative (n=31) P-value GLS global (%) - 20.24 (2.39) - 20.42 (3.65) 0.895 GLS 4-chambers (%) - 20.66 (1.91) - 20.09 (4.12) 0.720 GLS 2-chambers (%) - 23.02 (5.23) - 21.97 (3.89) 0.924 GLS 3-chambers (%) - 17.11 (2.60) - 19.31 (5.26) 0.015 GLS apical - anterior - 19.60 (6.12) - 17.72 (4.42) 0.857 - inferior - 26.89 (7.79) - 23.65 (5.46) 0.581 - lateral - 18.91 (2.04) - 18.13 (5.12) 0.508 - septal - 22.68 (7.14) - 21.76 (7.04) 0.844 GLS basal - anterior - 23.35 (3.82) - 22.75 (8.36) 0.752 - anteroseptal - 14.09 (4.74) - 18.66 (7.46) 0.109 - inferior - 22.69 (8.49) - 22.78 (6.94) 0.818 - lateral - 19.99 (7.68) - 22.55 (7.01) 0.218 - septal - 14.26 (4.63) - 18.07 (8.79) 0.081 GLS mid - inferior - 23.09 (6.12) - 22.58 (5.07) 0.917 - septal - 14.80 (5.69) - 17.50 (7.53) 0.056 - anterior - 20.54 (3.28) - 19.73 (6.52 0.026 - anteroseptal - 14.70 (4.96) - 18.13 (5.20) 0.010 - lateral - 18.64 (5.79) - 20.09 (5.73) 0.270 Data are reported as mean (S.D.). GLS, global longitudinal strain. Figure 1. Conclusion This simple ultrasound technique allows detection of myocardial dysfunction associated with scars in SSc patients, or its absence in matched controls. Patients with prior digital ulcerations and low body weight have the strongest association with inferoseptal myocardial scars. eSCAR may help detect subclinical myocardial fibrosis in SSc. Disclosure of Interests None declared